Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes

Olivia McCarthy; Rachel Deere; Rachel Churm; Gareth J. Dunseath; Charlotte Jones; Max L. Eckstein; David M. Williams; Jennifer Hayes; Jason Pitt; Stephen C. Bain; Othmar Moser; Richard M. Bracken

doi:10.1016/j.numecd.2020.07.043

Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes

Olivia McCarthy, Rachel Deere, Rachel Churm, Gareth J. Dunseath, Charlotte Jones, Max L. Eckstein, David M. Williams, Jennifer Hayes, Jason Pitt, Stephen C. Bain, Othmar Moser, Richard M. Bracken

Research output: Contribution to journal › Article › peer-review

18 Citations (SciVal)

Abstract

Aim: To detail the extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin dose adjustments in individuals with type 1 diabetes (T1D) using multiple daily injections of insulins aspart (IAsp) and degludec (IDeg). Methods and results: Sixteen individuals with T1D, completed a single-centred, randomised, four-period crossover trial consisting of 23-h inpatient phases. Participants administered either a regular (100%) or reduced (50%) dose (100%; 5.1 ± 2.4, 50%; 2.6 ± 1.2 IU, p < 0.001) of individualised IAsp 1 h before and after 45-min of evening exercise at 60 ± 6% V̇O_2max. An unaltered dose of IDeg was administered in the morning. Metabolic, physiological and hormonal responses during exercise, recovery and nocturnal periods were characterised. The primary outcome was the number of trial day occurrences of hypoglycemia (venous blood glucose ≤ 3.9 mmol L ⁻¹). Inclusion of a 50% IAsp dose reduction strategy prior to evening exercise reduced the occurrence of in-exercise hypoglycemia (p = 0.023). Mimicking this reductive strategy in the post-exercise period decreased risk of nocturnal hypoglycemia (p = 0.045). Combining this strategy to reflect reductions either side of exercise resulted in higher glucose concentrations in the acute post-exercise (p = 0.034), nocturnal (p = 0.001), and overall (p < 0.001) periods. Depth of hypoglycemia (p = 0.302), as well as ketonic and counter-regulatory hormonal profiles were similar. Conclusions: These findings demonstrate the glycemic safety of peri-exercise bolus dose reduction strategies in minimising the prevalence of acute and nocturnal hypoglycemia following evening exercise in people with T1D on MDI. Use of newer background insulins with current bolus insulins demonstrates efficacy and advances current recommendations for safe performance of exercise. Clinical trials register: DRKS00013509.

Original language	English
Pages (from-to)	227-236
Journal	Nutrition, Metabolism and Cardiovascular Diseases
Volume	31
Issue number	1
Early online date	6 Aug 2020
DOIs	https://doi.org/10.1016/j.numecd.2020.07.043
Publication status	Published - 4 Jan 2021

Funding

This study was funded by Novo Nordisk A/S as part of an Investigator Sponsored Study. Olivia McCarthy? has received a Zienkiewcz scholarship and travel grants from Novo Nordisk UK. Othmar Moser has received lecture fees from Medtronic, travel grants from Novo Nordisk A/S, Novo Nordisk AT, Novo Nordisk UK, Medtronic AT, research grants from S?r Cymru II COFUND fellowship/European Union, Novo Nordisk A/S and Novo Nordisk AT as well as material funding from Abbott Diabetes Care. Max L. Eckstein has received a KESS2/European Social Fund scholarship and travel grants from Novo Nordisk A/S. Stephen C. Bain has received research grants (includes principal investigator, collaborator or consultant and pending grants as well as grants already received) from Health and Care Research Wales and Novo Nordisk. He has received other research support from Health and Care Research Wales, honoraria from Novo Nordisk, Sanofi, Lilly, Boehringer Ingelheim and Merck, and has an ownership interest in Glycosmedia (diabetes on-line news service). Richard M. Bracken reports having received honoraria, travel, and educational grant support from Boehringer-Ingelheim, Eli Lilly and Company, Novo Nordisk, and Sanofi-Aventis. The remaining authors have no relevant conflict of interest to disclose. This study was funded by Novo Nordisk A/S as part of an Investigator Sponsored Study. Olivia McCarthy∗ has received a Zienkiewcz scholarship and travel grants from Novo Nordisk UK . Othmar Moser has received lecture fees from Medtronic , travel grants from Novo Nordisk A/S , Novo Nordisk AT , Novo Nordisk UK , Medtronic AT , research grants from Sêr Cymru II COFUND fellowship/European Union , Novo Nordisk A/S and Novo Nordisk AT as well as material funding from Abbott Diabetes Care . Max L. Eckstein has received a KESS2/European Social Fund scholarship and travel grants from Novo Nordisk A/S . Stephen C. Bain has received research grants (includes principal investigator, collaborator or consultant and pending grants as well as grants already received) from Health and Care Research Wales and Novo Nordisk . He has received other research support from Health and Care Research Wales , honoraria from Novo Nordisk , Sanofi , Lilly , Boehringer Ingelheim and Merck , and has an ownership interest in Glycosmedia (diabetes on-line news service). Richard M. Bracken reports having received honoraria, travel, and educational grant support from Boehringer-Ingelheim , Eli Lilly and Company , Novo Nordisk, and Sanofi-Aventis . The remaining authors have no relevant conflict of interest to disclose.

Keywords

Exercise
Hypoglycemia
Insulin aspart
Insulin degludec
Type 1 diabetes

ASJC Scopus subject areas

Medicine (miscellaneous)
Endocrinology, Diabetes and Metabolism
Nutrition and Dietetics
Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.numecd.2020.07.043Licence: CC BY-NC-ND

Cite this

McCarthy, O., Deere, R., Churm, R., Dunseath, G. J., Jones, C., Eckstein, M. L., Williams, D. M., Hayes, J., Pitt, J., Bain, S. C., Moser, O., & Bracken, R. M. (2021). Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes. Nutrition, Metabolism and Cardiovascular Diseases, 31(1), 227-236. https://doi.org/10.1016/j.numecd.2020.07.043

Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes. / McCarthy, Olivia; Deere, Rachel; Churm, Rachel et al.
In: Nutrition, Metabolism and Cardiovascular Diseases, Vol. 31, No. 1, 04.01.2021, p. 227-236.

Research output: Contribution to journal › Article › peer-review

McCarthy, O, Deere, R, Churm, R, Dunseath, GJ, Jones, C, Eckstein, ML, Williams, DM, Hayes, J, Pitt, J, Bain, SC, Moser, O & Bracken, RM 2021, 'Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes', Nutrition, Metabolism and Cardiovascular Diseases, vol. 31, no. 1, pp. 227-236. https://doi.org/10.1016/j.numecd.2020.07.043

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abstract = "Aim: To detail the extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin dose adjustments in individuals with type 1 diabetes (T1D) using multiple daily injections of insulins aspart (IAsp) and degludec (IDeg). Methods and results: Sixteen individuals with T1D, completed a single-centred, randomised, four-period crossover trial consisting of 23-h inpatient phases. Participants administered either a regular (100\%) or reduced (50\%) dose (100\%; 5.1 ± 2.4, 50\%; 2.6 ± 1.2 IU, p < 0.001) of individualised IAsp 1 h before and after 45-min of evening exercise at 60 ± 6\% {\.V}O2max. An unaltered dose of IDeg was administered in the morning. Metabolic, physiological and hormonal responses during exercise, recovery and nocturnal periods were characterised. The primary outcome was the number of trial day occurrences of hypoglycemia (venous blood glucose ≤ 3.9 mmol L −1). Inclusion of a 50\% IAsp dose reduction strategy prior to evening exercise reduced the occurrence of in-exercise hypoglycemia (p = 0.023). Mimicking this reductive strategy in the post-exercise period decreased risk of nocturnal hypoglycemia (p = 0.045). Combining this strategy to reflect reductions either side of exercise resulted in higher glucose concentrations in the acute post-exercise (p = 0.034), nocturnal (p = 0.001), and overall (p < 0.001) periods. Depth of hypoglycemia (p = 0.302), as well as ketonic and counter-regulatory hormonal profiles were similar. Conclusions: These findings demonstrate the glycemic safety of peri-exercise bolus dose reduction strategies in minimising the prevalence of acute and nocturnal hypoglycemia following evening exercise in people with T1D on MDI. Use of newer background insulins with current bolus insulins demonstrates efficacy and advances current recommendations for safe performance of exercise. Clinical trials register: DRKS00013509.",

keywords = "Exercise, Hypoglycemia, Insulin aspart, Insulin degludec, Type 1 diabetes",

author = "Olivia McCarthy and Rachel Deere and Rachel Churm and Dunseath, \{Gareth J.\} and Charlotte Jones and Eckstein, \{Max L.\} and Williams, \{David M.\} and Jennifer Hayes and Jason Pitt and Bain, \{Stephen C.\} and Othmar Moser and Bracken, \{Richard M.\}",

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T1 - Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes

AU - McCarthy, Olivia

AU - Deere, Rachel

AU - Churm, Rachel

AU - Dunseath, Gareth J.

AU - Jones, Charlotte

AU - Eckstein, Max L.

AU - Williams, David M.

AU - Hayes, Jennifer

AU - Pitt, Jason

AU - Bain, Stephen C.

AU - Moser, Othmar

AU - Bracken, Richard M.

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N2 - Aim: To detail the extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin dose adjustments in individuals with type 1 diabetes (T1D) using multiple daily injections of insulins aspart (IAsp) and degludec (IDeg). Methods and results: Sixteen individuals with T1D, completed a single-centred, randomised, four-period crossover trial consisting of 23-h inpatient phases. Participants administered either a regular (100%) or reduced (50%) dose (100%; 5.1 ± 2.4, 50%; 2.6 ± 1.2 IU, p < 0.001) of individualised IAsp 1 h before and after 45-min of evening exercise at 60 ± 6% V̇O2max. An unaltered dose of IDeg was administered in the morning. Metabolic, physiological and hormonal responses during exercise, recovery and nocturnal periods were characterised. The primary outcome was the number of trial day occurrences of hypoglycemia (venous blood glucose ≤ 3.9 mmol L −1). Inclusion of a 50% IAsp dose reduction strategy prior to evening exercise reduced the occurrence of in-exercise hypoglycemia (p = 0.023). Mimicking this reductive strategy in the post-exercise period decreased risk of nocturnal hypoglycemia (p = 0.045). Combining this strategy to reflect reductions either side of exercise resulted in higher glucose concentrations in the acute post-exercise (p = 0.034), nocturnal (p = 0.001), and overall (p < 0.001) periods. Depth of hypoglycemia (p = 0.302), as well as ketonic and counter-regulatory hormonal profiles were similar. Conclusions: These findings demonstrate the glycemic safety of peri-exercise bolus dose reduction strategies in minimising the prevalence of acute and nocturnal hypoglycemia following evening exercise in people with T1D on MDI. Use of newer background insulins with current bolus insulins demonstrates efficacy and advances current recommendations for safe performance of exercise. Clinical trials register: DRKS00013509.

AB - Aim: To detail the extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin dose adjustments in individuals with type 1 diabetes (T1D) using multiple daily injections of insulins aspart (IAsp) and degludec (IDeg). Methods and results: Sixteen individuals with T1D, completed a single-centred, randomised, four-period crossover trial consisting of 23-h inpatient phases. Participants administered either a regular (100%) or reduced (50%) dose (100%; 5.1 ± 2.4, 50%; 2.6 ± 1.2 IU, p < 0.001) of individualised IAsp 1 h before and after 45-min of evening exercise at 60 ± 6% V̇O2max. An unaltered dose of IDeg was administered in the morning. Metabolic, physiological and hormonal responses during exercise, recovery and nocturnal periods were characterised. The primary outcome was the number of trial day occurrences of hypoglycemia (venous blood glucose ≤ 3.9 mmol L −1). Inclusion of a 50% IAsp dose reduction strategy prior to evening exercise reduced the occurrence of in-exercise hypoglycemia (p = 0.023). Mimicking this reductive strategy in the post-exercise period decreased risk of nocturnal hypoglycemia (p = 0.045). Combining this strategy to reflect reductions either side of exercise resulted in higher glucose concentrations in the acute post-exercise (p = 0.034), nocturnal (p = 0.001), and overall (p < 0.001) periods. Depth of hypoglycemia (p = 0.302), as well as ketonic and counter-regulatory hormonal profiles were similar. Conclusions: These findings demonstrate the glycemic safety of peri-exercise bolus dose reduction strategies in minimising the prevalence of acute and nocturnal hypoglycemia following evening exercise in people with T1D on MDI. Use of newer background insulins with current bolus insulins demonstrates efficacy and advances current recommendations for safe performance of exercise. Clinical trials register: DRKS00013509.

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Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes

Abstract

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UN SDGs

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Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

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